Effects of Pretransplantation Treatment With Rituximab on Outcomes of Autologous Stem-Cell Transplantation for Non-Hodgkin’s Lymphoma Amy L. Hoerr, Feng Gao, Josephine Hidalgo, Divya Tiwari, Kristie A. Blum, Vikram Mathews, Douglas R. Adkins, William Blum, Steven Devine, Ravi Vij, Lawrence T. Goodnough, John F. Dipersio, and Hanna J. Khoury A B S T R A C T Purpose To analyze the effects of preautografting treatment with rituximab (R) on stem-cell mobilization, post-transplantation complications, engraftment, disease-free survival, and overall survival in patients with non-Hodgkin’s lymphoma (NHL). Patients and Methods Single-institution retrospective comparative outcome analysis in a cohort of 273 relapsed chemosensitive NHL patients of whom 127 (47%) received R pretransplantation. Results R was administered a median of 3 months before autologous transplantation. When com- pared to the nonrituximab group, R patients were older (56 v 50 years; P  .001), and had delays in post-transplantation platelets recovery (39 v 27 days; P = .001). Pretransplan- tation R did not affect stem-cell mobilization, post-transplantation early complications, duration of hospitalization, or mortality rates at days 30 and 100. In contrast to patients with low-grade NHL, both disease-free and overall survival rates were significantly better when R was included in the pretransplantation salvage therapy for patients with intermediate-grade NHL. Conclusion In this large, single-center retrospective analysis, pretransplantation treatment with R was associated with improved survival in patients with intermediate-grade NHL, at the price, however, of a delay in platelet engraftment. J Clin Oncol 22:4561-4566. © 2004 by American Society of Clinical Oncology INTRODUCTION Rituximab (R; Rituxan; IDEC Pharmaceuti- cals, San Diego, CA) is a monoclonal anti- body against CD20 with significant activity against B-cell non-Hodgkin’s lymphoma (NHL). 1,2,3 R has been commonly incorpo- rated in salvage chemotherapy regimens for relapsed disease, and is increasingly used in first-line therapy in combination with che- motherapy for newly diagnosed patients. Indeed, recent reports show improved re- sponse rates and overall survival (OS) in older patients with diffuse large B-cell NHL from the addition of R to standard-dose cyclo- phosphamide, doxorubicin, vincristine, and prednisone (CHOP). 4 R has also been safely and successfully incorporated in the mobiliza- tion and conditioning regimens for autolo- gous stem-cell transplantation (ASCT). 5-9 The impact of pretransplantation administration of a highly active agent such as R on the out- comes of ASCT for NHL is unknown. We therefore designed a retrospective study to an- alyze stem-cell mobilization, early post- transplantation complications, engraftment, From the School of Medicine, Siteman Cancer Center, Division of Oncology, Section of Bone Marrow Transplantation and Leukemia; Division of Biostatistics, Washington University, St Louis, MO. Submitted May 10, 2004; accepted August 31, 2004. Presented as a poster at the 39th Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 31-June 3, 2003. Authors’ disclosures of potential con- flicts of interest are found at the end of this article. Address reprint requests to Hanna Khoury, MD, FACP, Emory University School of Medicine, 1365-C Clifton Rd NE, Suite C3007, Atlanta, GA 30322; e-mail: hanna_khoury@ emoryhealthcare.org. © 2004 by American Society of Clinical Oncology 0732-183X/04/2222-4561/$20.00 DOI: 10.1200/JCO.2004.05.035 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 22  NUMBER 22  NOVEMBER 15 2004 4561 Downloaded from ascopubs.org by 54.210.127.208 on June 20, 2022 from 054.210.127.208 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.